It’s a Sunday evening in Mexico City. It’s getting dark outside, and it is surprisingly quiet for a day on which Mexico elected its first leftist president in decades. Or maybe there is joy. Maybe there is noise. Maybe there is celebration. But it is, as if by some cosmic force, these things cannot reach me in my rented apartment.
I make my fifth or sixth call to another emergency room. “Buenas noches,” I stammer. “Tengo una pregunta. Tenía un encuentro con un hombre con VIH. Tiene profilaxis postexposición?” Good evening. I have a question. I had an encounter with an HIV-positive man. Do you have post-exposure prophylaxis?
In the United States, we call it PeP — a combination of medications taken within 72 hours after an exposure to HIV that can keep that person from becoming positive. Medical professionals use it after needle sticks from positive or status-unknown patients. It’s also available for people who’ve shared needles, been sexually assaulted, or had unsafe sex with an HIV-positive person or a person whose status is unknown. For the most part, every hospital in the United States has this protocol. That is not the case in Mexico City.
I keep dialing phone numbers, but the same conversation — on repeat, on hold, on repeat — becomes ever more desperate. I text friends back home, text lovers and friends here in Mexico City, too. The universal message is you’ll be fine, there’s nothing you can do right now, calm down.
Nothing is comfort, though. I pace the apartment’s uneven hardwood floors. Make trips to the sink to splash myself with cold water and stare at my face, whispering curses at my own stupidity. Over and over again, the nurses and hospital workers tell me: “Tomorrow morning.
Clinica Condesa. They will help you.” By tomorrow morning, nearly 36 hours will have elapsed — and in a situation where literally every hour can matter, this inability to receive immediate help is the most paralyzing thing. That night, the emergency sleeping pills I keep do nothing at all to put my brain to rest.
We are in a new age of HIV — one that is both more hopeful than ever and not at the same time. This is an age where my worry, in many ways, is unfounded. As of 2017, UNAIDS estimates that nearly 37 million people worldwide are living with HIV. Rates of infection in the United States and other nations are falling, and new infections in 2017 numbered 1.8 million. Of those who are positive, 57 percent are receiving antiretroviral treatment (ART), which keeps them completely healthy and prevents the virus from spreading to their sexual partners even during unprotected sex. This has been proven in study after study, again and again. In much of the Western world, and among most people in the middle and upper classes in those nations, HIV is now a long-term condition that is relatively easy to manage and avoid. For those outside of that socio-economic group and among certain minorities, though, rates of new infections are climbing.
I suspect it has something to do with my arrogance and complacency as a gay man from New York City.
Despite decades of indoctrination about safe sex, I failed to protect myself in Mexico. In the end, there are no excuses, but I suspect it has something to do with my arrogance and complacency as a gay man from New York City. In 2012, the FDA approved Truvada as PreP — pre-exposure prophylaxis — as a means for preventing HIV infection. While PeP is taken as an emergency measure after an HIV exposure, PreP is taken daily and has been proven to be around 99 percent effective in keeping people HIV-negative, even with HIV-positive partners. The AP reports that in early 2018, New York City estimated that 30 percent of its male gay and bisexual citizens was taking Truvada as PreP. Walk down the halls of a subway station and you’re likely to encounter bright advertisements touting PreP. Have a conversation about hooking up as a gay man, and PreP will come up.
PreP works because it protects both the person taking it from potential infections, and — by virtue of this fact — prevents them from passing HIV to their sex partners. Therefore, as long as one partner is negative and regularly taking PreP, or is undetectable, the chances of passing HIV or contracting HIV are statistically zero. Condoms have, for purposes of preventing HIV among gay men, fallen to the wayside in many cases. Despite some of us — and it really is only some of us — having this luxury, these choices are not without their risks. Some obvious, and some less so.
When we go abroad, we talk about expansion, about existing in a place that is — by virtue of its difference — a bit strange to you. But while international travel demands you accept the contrasts between one place and another, in practice we are often unprepared. You cannot ever go abroad thinking that you will have the same access to anything you had back home. Even in countries that enjoy similar qualities of life, infrastructure, and the like, you’re often contending with language barriers, different health care systems, different customs, and different laws. You’re also contending with your own psychology.
Studies consistently reveal that travel unleashes some of the prohibitions we hold over our own heads when we are home, within the confines of our normal lives. This fact cuts across all genders and sexual preferences. One such study concluded that European men seeking men while traveling abroad were more than twice as likely to forego condoms while having sex. The study put the number of travelers who didn’t use condoms at around 50 percent. This fact was confirmed in a 2016 Swedish study that revealed similar percentages of unsafe sex in both men and women traveling abroad, as well as a 2010 study, which also found that travel-related STIs are three-times as common among those having casual sex abroad.
Now, consider the four most popular international destinations for United States travelers: Mexico, Canada, the U.K., and the Dominican Republic. Public morals, economic wellbeing, and healthcare systems vary greatly between these four countries, and yet it’s fair few Americans know how this translates on the ground, particularly relating to HIV and STI prevention. At the time of writing, PreP is available in Canada, available to a limited degree in the U.K., and generally not available in Mexico and only through limited clinics in the Dominican Republic. PeP is available at most emergency rooms in Canada and many hospitals in the U.K. In Mexico, it’s only available through certain government-funded clinics and not at hospitals, meaning that it’s not available 24/7. Trying to determine whether PeP is available in the Dominican Republic is challenging — it may be available to victims of sexual assault, as well as at some clinics. And this lack of consistency in treatment and prevention regimens — from country to country and even within a single country — is really the heart of the problem when we talk about having sex abroad.
It’s been over 30 years since AIDS became a global nightmare. And yet, to this day, there is no global resource for examining reliable HIV statistics, locating treatment services if you are newly diagnosed, and locating access to PeP. UNAIDS is generally considered the global clearinghouse for HIV-related data, but it relies on countries to self-report their facts and figures, leading to dramatic undercounting in certain instances. It also doesn’t universalize the information available: There is no master list of clinics, hospitals, protocols, or anything of the like to direct anyone to resources for treatment or prevention.
Additionally, access to PreP continues to meet hurdles because of its high per-pill cost as well as ongoing moral crusades that marginalize already stigmatized groups: minorities, the poor, sex workers, homosexuals, and transgender individuals. If you are abroad and you have an unsafe encounter with someone of unknown status or with someone who is positive but not receiving ART, you may not be able to find an immediate, clear, and reliable answer as to where and how you might seek treatment. What’s more? Even in the United States, PeP protocols vary.
This is to say nothing of rising global threats in non-viral STIs like gonorrhea, chlamydia, and syphilis. Gonorrhea, in particular, is becoming more and more resistant to first- and second-line antibiotics. Again, one of the culprits here seems to be casual sex while traveling. A much-publicized case of so-called super-gonorrhea came about in the U.K. in a man who was believed to have caught it from an encounter with a woman while traveling in Southeast Asia, according to Business Insider. Since then, similar cases have arisen elsewhere in the world.
I’d come to Mexico City six times in the year before this visit. I’d made friends here, developed intimacies, and found loves and people for whom I care deeply. It’s become something of an escape and a second home. It was a place that felt easy and safe to me — a place where I liked the version of myself I became.
On one of my earlier visits, my friend and I had been in a very strong earthquake in Oaxaca. Afterward, I had this dream where I was on some future visit, alone in Mexico City during an earthquake. As bricks fell down all around, I ran through the streets looking for a man who is very dear to me. As it happened in reality, there was no earthquake this time around, just the feeling that everything had been shaken, deeply — the metaphor almost too perfect.
I know, rationally, that if I don’t get access to Pep in time, my life will change very little.
I know, rationally, that if I don’t get access to Pep in time, my life will change very little. Being HIV-positive and of a certain class with a stable, salaried job and health insurance while having access to New York City’s massive network of HIV-related health care options will likely translate into nothing more than the addition of another daily pill or two. This is exactly what my HIV-positive, undetectable friends have been trying to drill into my head for years now. But memory isn’t subject to rational thought. In fact, memory most often operates free from logic. We erase and magnify our memories to make them most convenient to what are currently feeling. This is how we feel about current lovers and exes, how we process our own successes and failures well after they’ve happened. My memory is long enough to remember the late ‘80s and early ‘90s, when HIV was not to be taken lightly at all. These sort of traumas are not erased with science and progress. They linger.
In Mexico City, it’s still black night outside when my friend takes me to the clinic, where we wait in line for an hour. We find sweet coffee and conchas from a vendor down the block as dozens of men, women, and children line up for the clinic’s services. There’s so much time, really, in all of this waiting — blood draws, nurses to visit, doctors to speak with, medicine to get, photocopies to make. The mind starts running through everything you’ve ever done, all the men you’ve ever slept with, the reasons why you made certain choices and not others. The man with whom I had the exposure is also at the clinic. We talk a bit. He looks terrified too. I want to hug him, even though I don’t exactly know him well, beyond a few Instagram conversations.
I was once told that I only see the world in black and white — that the entire rich spectrum of gray is an unfathomable thing to me. And maybe that’s why this whole incident felt like being body slammed into the floor; why, despite knowing the facts about modern life with HIV for men like me, I couldn’t shake the feeling that life as I knew it would change — this stupid, old stigma doesn’t evaporate the way it should. It takes hard, deep work to dismantle it. I feared that I would perceive my connection to every friend, family member, and human body around me as changed, regardless of how those very people actually perceive me.
Connection is both the most natural and the most elusive part of our human condition. Our songs and books are about it, and yet we make it incredibly hard on ourselves to connect with or stay connected to one another. Our private electronic devices give us access to forums where our faces, our preferences, and our desires are incredibly public. Casual sex, hookup culture, whatever you want to call it is in many ways the most contemporary symptom of the convergence of these two divergent poles: the public and private. In Mexico, I dropped my guard, based on assumptions I could semi-safely make back home. And I learned the hard way that in this new age, the stakes are entirely different — they’re uneven, at best, safer and less so depending on the luck of geography and means. There are still, it seems, hard lessons to be learned.